The fairness debate will put health back on the front pages

This week, HSJ reports signs that the sector’s lower profile will be predictably short lived.

For the last year, health secretary Andrew Lansley has been in the media spotlight as he painfully forced the Health Bill through Parliament. This high profile means that whatever the long term success of clinical commissioning groups and the NHS Commissioning Board, the Conservatives’ neutralisation of health – Labour’s trump card before David Cameron became the Tory leader – as a political issue at the 2010 general election seems a distant memory from a bygone political era.

The government has changed so many things that come the next election either its health achievements will be seen as electoral assets or it will lose the argument to those who can weave a health narrative combining discord about reform, spending restraint and performance of services.

But questions of fairness will also emerge – questions the government currently faces on many fronts. A Budget perceived by many as being ignorant of the pressures faced by those fabled “hard-working families” has given rise to accusations that we are led by “arrogant posh boys who don’t know the price of milk”.

Both Mr Lansley and the NHS now face the risk that controversial policies that would have been implemented without the act – from the £20bn savings programme to the franchising of hospitals to private operators – will become linked to the reforms in the minds of the public.

HSJ’s revelation this week of the surpluses needed by Hinchingbrooke Health Care Trust if it is to pay off its debts and give its private operator Circle its cut will give ammunition to both sides of the argument.

Profits are private providers’ requirement to enter into the NHS to diversify service provision and Circle faces a battle to turn around the fortunes of Hinchingbrooke. But in the current climate it is not difficult to imagine private providers’ fees being seen as an example of a society in which the perceived fatcats get the cream. That the franchising of Hinchingbrooke was first contemplated under a Labour government will not necessarily be remembered by the electorate.

Signals that George Eliot Hospital Trust may follow a similar path to Hinchingbrooke will only increase the heat of the debate about diversifying NHS provision.

Mr Lansley has used HSJ to firmly rope himself to the competition mast. He is used to choppy waters but the government of which he is a part has looked queasy in recent weeks. Now is the time we will find out how far ministers are prepared to push the competition issue.

It is not only competition that will stir controversy. Mr Lansley used a speech last week to suggest that numbers of older people should be a greater determinant of local health budgets.

It is overly simplistic to suggest that this principle would result in cash being transferred from poorer Labour-voting areas to richer Conservative-voting retirement resorts.

However, the issue, like NHS competition and so many of the problems with which the government is grappling, is linked to wider questions about the fairness of society in tough times. It is this debate that will determine the political mood over the next year and, potentially, the fate of this government.